PROPERTYTRANSFERNOTIFICATIONCERTIFICATION
Thisformistobesignedbytheprospectivepurchaserbeforesigningapurchaseandsaleagreementora memorandumofagreement,orbythelessee-prospectivepurchaserbeforesigningaleasewithanoption topurchaseforresidentialpropertybuiltbefore1978,forcompliancewithfederalandMassachusetts lead-basedpaintdisclosurerequirements.
RequiredFederalLeadWarningStatement:
Everypurchaserofanyinterestinresidentialpropertyonwhicharesidentialdwellingwasbuiltpriorto1978isnotifiedthat suchpropertymaypresentexposuretoleadfromlead-basedpaintthatmayplaceyoungchildrenatriskofdevelopinglead poisoning.Leadpoisoninginyoungchildrenmayproducepermanentneurologicaldamage,includinglearningdisabilities, reducedintelligencequotient,behavioralproblemsandimpairedmemory.Leadpoisoningalsoposesaparticularriskto pregnantwomen.Thesellerofanyinterestinresidentialrealpropertyisrequiredtoprovidethebuyerwithanyinformation onlead-basedpainthazardsfromriskassessmentsorinspectionsintheseller'spossessionandnotifythebuyerofanyknown lead-basedpainthazards.Ariskassessmentorinspectionforpossiblelead-basedpainthazardsisrecommendedpriorto purchase.
Seller'sDisclosure
(a)Presenceoflead-basedpaintand/orlead-basedpainthazards(check(i)or(ii)below):
(i)Knownlead-basedpaintand/orlead-basedpainthazardsarepresentinthehousing(explain).
(ii)Sellerhasnoknowledgeoflead-basedpaintand/orlead-basedpainthazardsinthehousing.
(b)Recordsandreportsavailabletotheseller(check(i)or(ii)below):
(i) Sellerhasprovidedthepurchaserwithallavailablerecordsandreportspertainingtolead-basedpaint and/orlead-basedpainthazardsinthehousing(checkdocumentsbelow).
LeadInspectionReport; RiskAssessmentReport; LetterofInterimControl; LetterofCompliance
(ii)Sellerhasnoreportsorrecordspertainingtolead-basedpaintand/orlead-basedpainthazardsinthe housing.
Purchaser'sorLesseePurchaser'sAcknowledgment(initial)
(c) Purchaser or lessee purchaser has received copies of all documents checked above.
(d) Purchaser or lessee purchaser has received no documents.
(e) Purchaser or lessee purchaser has received the Property Transfer Lead Paint Notification.
(f) Purchaser or lessee purchaser has (check (i) or (ii) below):
(i) received a 10-day opportunity (or mutually agreed upon period) to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards; or (ii) waived the opportunity to conduct a risk assessment or inspection for the presence of lead-based paint and/or lead-based paint hazards.
Agent'sAcknowledgment (initial)
(g)Agenthasinformedtheselleroftheseller'sobligationsunderfederalandstatelawforlead-based paintdisclosureandnotification,andisawareofhis/herresponsibilitytoensurecompliance.
(h)Agenthasverballyinformedpurchaserorlessee-purchaserofthepossiblepresenceofdangerous levelsofleadinpaint,plaster,puttyorotherstructuralmaterialsandhisorherobligationtobringapropertyinto compliancewiththeMassachusettsLeadLaw--eitherthroughfulldeleadingorinterimcontrol--ifitwasbuilt before1978andachildundersixyearsoldresidesorwillresideintheproperty.
CertificationofAccuracy
Thefollowingpartieshavereviewedtheinformationaboveandcertify,tothebestoftheirknowledge,thatthe informationtheyhaveprovidedistrueandaccurate.
Seller Date Seller Date
Purchaser